Rotational alignment of corneal endothelial grafts and risk of graft detachment after Descemet membrane endothelial keratoplasty: a double-masked pseudo-randomized study.
complication
descemet membrane endothelial keratoplasty
incomplete graft attachment
rebubbling
Journal
Acta ophthalmologica
ISSN: 1755-3768
Titre abrégé: Acta Ophthalmol
Pays: England
ID NLM: 101468102
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
revised:
08
02
2021
received:
26
10
2020
accepted:
23
02
2021
pubmed:
21
3
2021
medline:
28
1
2022
entrez:
20
3
2021
Statut:
ppublish
Résumé
The posterior cornea is rotationally asymmetric, and Descemet membrane endothelial keratoplasty (DMEK) grafts preferentially scroll vertically. This prospective study assessed whether graft attachment after DMEK differed depending on the rotational alignment of the donor graft in the recipient eye. Pseudo-randomization and blinding of the graft orientation in the recipient's eye were possible by procedural separation: (1) The eye bank recorded the position of an orientation marker in the donor cornea; (2) the surgeon preparing the DMEK graft recorded an upside-down marker relative to the eye bank marker; and (3) the surgeon assessed the position of the upside-down marker in the recipient after DMEK. Surgeons were masked towards the eye bank marker. Using mixed-effects models, we assessed graft attachment relative to the rotational alignment of the donor graft. Postoperatively, the graft was not fully attached in 59 of 179 eyes (33%). A second air fill (rebubbling) was performed in 11%. The graft axis was in line with the recipient cornea axis in 40%, oblique in 28% and orthogonal in 32%. We did not detect an elevated risk of incomplete attachment (odds ratio [OR], 1.16; 95% CI, 0.61-2.20), risk of rebubbling (OR, 1.25; 95% CI, 0.47-3.31) or larger areas of graft detachment in non-aligned grafts compared to aligned grafts. Rotational alignment was not strongly associated with the risk of incomplete graft attachment, although modestly elevated risks cannot be ruled out. Efforts are needed to reduce the need for rebubbling after DMEK and to identify modifiable risk factors for graft detachment.
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1334-e1339Subventions
Organisme : Program for Clinical Studies and Berta-Ottenstein-Program for Clinician Scientists, Faculty of Medicine Freiburg, Germany
Organisme : Freiburg Lions Club, Germany
Organisme : Deutsche Ophthalmologische Gesellschaft
Informations de copyright
© 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.
Références
Aldave AJ, Terry MA, Szczotka-Flynn LB et al. (2019): Effect of graft attachment status and intraocular pressure on descemet stripping automated endothelial keratoplasty outcomes in the cornea preservation time study. Am J Ophthalmol 203: 78-88.
Bachmann BO, Laaser K, Cursiefen C & Kruse FE (2010): A method to confirm correct orientation of descemet membrane during descemet membrane endothelial keratoplasty. Am J Ophthalmol 149: 922-925 e922.
Baydoun L, van Dijk K, Dapena I et al. (2015): Repeat Descemet membrane endothelial keratoplasty after complicated primary Descemet membrane endothelial keratoplasty. Ophthalmology 122: 8-16.
Brockmann T, Brockmann C, Maier AK et al. (2014): Clinicopathology of graft detachment after Descemet's membrane endothelial keratoplasty. Acta Ophthalmol 92: e556-561.
Deng SX, Lee WB, Hammersmith KM et al. (2018): Descemet membrane endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology 125: 295-310.
Greiner MA, Rixen JJ, Wagoner MD et al. (2014): Diabetes mellitus increases risk of unsuccessful graft preparation in Descemet membrane endothelial keratoplasty: a multicenter study. Cornea 33: 1129-1133.
Heinzelmann S, Bohringer D, Eberwein P et al. (2016): Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study. Graefes Arch Clin Exp Ophthalmol 254: 515-522.
Heinzelmann S, Bohringer D, Eberwein P et al. (2017): Graft dislocation and graft failure following Descemet membrane endothelial keratoplasty (DMEK) using precut tissue: a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol 255: 127-133.
Heinzelmann S, Bohringer D, Haverkamp C et al. (2018): Influence of postoperative intraocular pressure on graft detachment after descemet membrane endothelial keratoplasty. Cornea 37: 1347-1350.
Heinzelmann S, Huther S, Bohringer D et al. (2014): Influence of donor characteristics on descemet membrane endothelial keratoplasty. Cornea 33: 644-648.
Huang MJ, Kane S & Dhaliwal DK (2018): Descemetorhexis without endothelial keratoplasty versus DMEK for treatment of fuchs endothelial corneal dystrophy. Cornea 37: 1479-1483.
Hummel CD, Diakonis VF, Desai NR et al. (2017): Cyclorotation during femtosecond laser-assisted cataract surgery measured using iris registration. J Cataract Refract Surg 43: 952-955.
Koch DD, Ali SF, Weikert MP et al. (2012): Contribution of posterior corneal astigmatism to total corneal astigmatism. J Cataract Refract Surg 38: 2080-2087.
Kruse FE, Laaser K, Cursiefen C et al. (2011): A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea 30: 580-587.
Laaser K, Bachmann BO, Horn FK et al. (2011): Donor tissue culture conditions and outcome after descemet membrane endothelial keratoplasty. Am J Ophthalmol 151: 1007-1018 e1002.
Le VNH, Wabnig F, Bachmann B & Cursiefen C (2020): Epithelial downgrowth after Descemet membrane endothelial keratoplasty. Eur J Ophthalmol 10. https://doi.org/10.1177/1120672120912413.
Leon P, Parekh M, Nahum Y et al. (2018): Factors associated with early graft detachment in primary descemet membrane endothelial keratoplasty. Am J Ophthalmol 187: 117-124.
Lewis PN, White TL, Young RD et al. (2016): Three-dimensional arrangement of elastic fibers in the human corneal stroma. Exp Eye Res 146: 43-53.
Mohammed I, Ross AR, Britton JO et al. (2018): Elastin content and distribution in endothelial keratoplasty tissue determines direction of scrolling. Am J Ophthalmol 194: 16-25.
Moloney G, Petsoglou C, Ball M et al. (2017): Descemetorhexis without grafting for fuchs endothelial dystrophy-supplementation with topical ripasudil. Cornea 36: 642-648.
Nahum Y, Iovieno A, Lipari E et al. (2016): Graft-recipient collagen lamellar axis discrepancy is compatible with excellent visual acuity after descemet stripping automated endothelial keratoplasty. Cornea 35: 938-940.
Pels E & Rijneveld WJ (2009): Organ culture preservation for corneal tissue. Technical and quality aspects. Dev Ophthalmol 43: 31-46.
Price MO, Giebel AW, Fairchild KM & Price FW Jr (2009): Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology 116: 2361-2368.
Price MO, Lisek M, Feng MT & Price FW Jr (2017): Effect of donor and recipient diabetes status on descemet membrane endothelial keratoplasty adherence and survival. Cornea 36: 1184-1188.
Reinhard T, Bohringer D, Huschen D & Sundmacher R (2002): Chronic endothelial cell loss of the graft after penetrating keratoplasty: influence of endothelial cell migration from graft to host. Klin Monbl Augenheilkd 219: 410-416.
Rickmann A, Szurman P, Jung S et al. (2018): Impact of 10% SF6 gas compared to 100% air tamponade in Descemet's membrane endothelial keratoplasty. Curr Eye Res 43: 482-486.
Rodriguez-Calvo de Mora M, Groeneveld-van Beek EA, Frank LE et al. (2016): Association between graft storage time and donor age with endothelial cell density and graft adherence after descemet membrane endothelial keratoplasty. JAMA Ophthalmol 134: 91-94.
Schwarz C, Aldrich BT, Burckart KA et al. (2016): Descemet membrane adhesion strength is greater in diabetics with advanced disease compared to healthy donor corneas. Exp Eye Res 153: 152-158.
Siebelmann S, Kolb K, Scholz P et al. (2020): The Cologne rebubbling study: a reappraisal of 624 rebubblings after Descemet membrane endothelial keratoplasty. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2020-316478.
Siebelmann S, Lopez Ramos S, Scholz P et al. (2018a): Graft detachment pattern after descemet membrane endothelial keratoplasty comparing air versus 20% SF6 tamponade. Cornea 37: 834-839.
Siebelmann S, Ramos SL, Matthaei M et al. (2018b): Factors associated with early graft detachment in primary descemet membrane endothelial keratoplasty. Am J Ophthalmol 192: 249-250.
Ueno Y, Hiraoka T, Miyazaki M et al. (2015): Corneal thickness profile and posterior corneal astigmatism in normal corneas. Ophthalmology 122: 1072-1078.
Wacker K, Fritz M, Grewing V et al. (2020): Vertical scrolling axis of corneal endothelial grafts for Descemet membrane endothelial keratoplasty. Cornea in press. https://doi.org/10.1097/ICO.0000000000002583
Wacker K, McLaren JW & Patel SV (2015): Directional posterior corneal profile changes in Fuchs' endothelial corneal dystrophy. Invest Ophthalmol Vis Sci 56: 5904-5911.
Yuda K, Kato N, Takahashi H et al. (2019): Effect of graft shift direction on graft detachment and endothelial cell survival after descemet membrane endothelial keratoplasty. Cornea 38: 970-975.